Cassidy, Randall L

Cassidy, Randall L is an individual health care provider with primary practice located at 1120 E Broad St , Elyria OH 44035-6306. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Adult Health, which is considered as his primary health care specialty. Cassidy, Randall L can be contacted via phone (440) 365-2239.

Contact Information

Primary practice address
1120 E Broad St Elyria OH 44035-6306
Phone: (440) 365-2239
Fax: (440) 365-1366
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 258009 Ohio

Profile Details

NPI number 1629229539
LBN Legal business name Cassidy, Randall L
Credentials Certified Nurse Practitioner (CNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 9th, 2008
Last updated Nov 4th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629229539 NPPES
Ohio MEDICAID 0236248
Ohio Other 11937343
Ohio MEDICAID 2914234
Ohio MEDICAID 3025372

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